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Transplants, Neoral medication

How A Greek Mother Solved a Researcher’s Problem

 By Dr. Gifford Jones  Tuesday, October 12, 2010

How would you behave if you were a Mother living in Greece and your son was a transplant surgeon in England? Possibly you’d worry that the foul English weather might him cause ill health. Maybe fret that he might marry an English woman and never return home. As we all know Mothers do lose sleep fussing about their children. But in this case a Mother’s anxiety helped to produce “Neoral”, a medication that will help transplant patients live a longer and better life.

Our immune system is a double©edged sword.It can be our salvation when fighting infections. But it can be our ruin when we have a failing heart, kidney or liver. When another person’s organ is transplanted into our body, the immune system destroys it as surely as it kills unwanted germs. For decades researchers tried to solve this problem.

In 1972 Jean©Francoise Borel, a researcher at Sandoz Pharmaceutical Company in Basel Switzerland, discovered an antifungal antibiotic that appeared to fight organ rejection.

The compound, which became known as “Cyclosporin”, was given to Professor Sir Roy Calne of Cambridge University, England, to carry out clinical trials on patients. It worked and today over 200,000 transplant patients rely on “Cyclosporin” to survive.

The development of Cyclosporin has been one of the most important drugs in medical history. But doctors encountered several problems when using it to treat patients.

The first 90 days following a transplantation operation are critical. In order for the graft to survive it’s necessary to administer adequate doses of Cyclosporin.

But there’s a catch. Cyclosporin is a bit of a rebel and has a bad habit of not being absorbed from the intestine in a predictable amount.

This presented a perplexing problem for both doctors and patients. If physicians give too much of the drug it produces toxicity. If they give too little the organ is rejected. So doctors at Cambridge were scratching their heads wondering how they could make Cyclosporin enter the body in a more predictable way.

This is when the transplant surgeon’s Mother solved the puzzle. She had fretted for months that her son was not getting enough nourishment from terrible English food. To correct this she sent him pure Greek olive oil. ‘ 0*0*0* That’s when the green light suddenly flashed on in Cambridge. The researcher discovered that by changing Cyclosporin into an oil microemulsion a predictable amount would be absorbed from the intestines.

Dr. Richard Superina, a transplant surgeon at Toronto’s Hospital for Sick Children, says “Neoral has been a godsend for children”. Formerly absorption of the Cyclosporin depended on the length of the gastrointestinal tract. This presented a problem for babies with shorter intestines. Neoral circumvents this difficulty.

Previously post©operative children had to be kept on intravenous medication for days to provide adequate amounts of Cyclosporin. But this method of medication was also more toxic.

Now, Superina reports, he can start children on Neoral by mouth sooner and give smaller doses as absorption is better and more reliable. And decreased doses also mean decreased costs.

There’s other benefit. Professor H.H. Neumayer, a prominent German researcher, recently reported to the International Congress on Cyclosporin, in Seville, Spain, that his patients showed a 70 per cent improvement in kidney function after three months therapy on Neoral.

Dr. C.R. Stiller, chief of the transplant program at the University of Western Ontario, says the difference between Neoral and Cyclosporin is like the disparity between a Porche and a model™T Ford and patients should all be switched to the new medication.

What about the quality of life? Dr. Stiller reports that studies showed that transplant patients scored higher in this area than the average population. Even higher than doctors and nurses! He stresses that transplant patients enjoy life more and feel healthier and more fulfilled. They’ve been through a life and death experience and have learned the preciousness of day to day living.

Dr Superina reports that children who have a liver transplant for acute liver failure return to normal life within six months. They play baseball and hockey and are not subject to any more infections than other children.

Professor Barry Kahan, a researcher at the University of Texas Medical School, reminds us that every year over 60,000 North Americans die from severe heart failure alone. Others succumb prematurely from kidney and liver disease and could be saved by organ transplantation. But only 2,000 heart transplants can be done a year due to a lack of donor organs.

Transplant surgeons have a message for family doctors. In the past, due to the unpredictability of Cyclosporin absorption, it was not possible for them to look after post©operative transplant patients. Now that Neoral is available they will become part of the team.

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Dr. Gifford Jones  Bio
Dr. Gifford Jones Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He’s been a ship’s surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: http://www.mydoctor.ca/gifford-jones



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